title: Simultaneous presentation of Waldenström macroglobulinemia and multiple myeloma: multidisciplinary diagnosis, treatment and 30-month follow-up.
abstract: Waldenström macroglobulinemia and multiple myeloma are mature B-cell neoplasms deriving from post-germinal cells at different stages of differentiation. The simultaneous presentation of Waldenström macroglobulinemia and multiple myeloma in the same patient is a very rare phenomenon and, so far, only two cases have been described. We report the case of a 75-year Caucasian female patient, with a silent clinical history, who presented with anemia and two different monoclonal proteins (IgMκ and IgGκ). The trephine biopsy showed the presence of a dual population, represented by small lymphoplasmacytoid cells and by plasma cells, which infiltrated the bone marrow with a clearly different pattern. Both immunohistochemistry and flow cytometry demonstrated the biclonal origin such neoplastic cells, since lymphoplasmacytoid cells resulted IgMκ while plasma cells were IgGκ. This biclonal pattern was further confirmed by the demonstration of a different IgH gene rearrangement of the two neoplasms. The patient was treated with bortezomib, dexamethasone and rituximab, achieving partial remission of both Waldenström macroglobulinemia and multiple myeloma. After a 30-month follow-up, she is in stable disease. Multiple myeloma has been described in association with other indolent B-cell neoplasms, mostly chronic lymphocytic leukemia, while Waldenström macroglobulinemia can be followed by diffuse large B-cell lymphoma in some instances, after chemotherapy. The association of Waldenström macroglobulinemia and multiple myeloma seems to be very rare. Our study shows that an integrated diagnostic work-up is very useful in such cases, with an interesting role for flow cytometry. [J Clin Exp Hematop 53(1): 29-36, 2013].
authors.affiliation: Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Carulli
authors.forename: Eugenio M
authors.initials: EM
authors.lastname: Ciancia
authors.forename: Antonio
authors.initials: A
authors.lastname: Azzarà
authors.forename: Virginia
authors.initials: V
authors.lastname: Ottaviano
authors.forename: Susanna
authors.initials: S
authors.lastname: Grassi
authors.forename: Elena
authors.initials: E
authors.lastname: Ciabatti
authors.forename: Maria I
authors.initials: MI
authors.lastname: Ferreri
authors.forename: Melania
authors.initials: M
authors.lastname: Rocco
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marini
authors.forename: Mario
authors.initials: M
authors.lastname: Petrini
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D011719:Pyrazines / Q000008:administration & dosage; D000069283:Rituximab; D008258:Waldenstrom Macroglobulinemia / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001897:Boronic Acids; D011719:Pyrazines; D000069283:Rituximab; D000069286:Bortezomib; D003907:Dexamethasone